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Home My WebLink AboutPR17-17757CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21810 Copley Drive, Diamond Bar, CA 91765 PRESS (909) 839-7020 Fax; (909) 861-3117 Building Inspection Hotline (909) 839-7027 FIRMLY BUILDING PERMIT APPLICATION www cityofdiamondbar.com building@diamondbarea.gov � G JOB SITEADDRESSI f APN LOT TRACT OWNER t:- ' ` ti`'n + . 'n -i # .a`. ADDRESS eS C ] 5i Ir"i. CfTY : oM ZIP e:' TEL..,] APPLICANT 1A ' r. :. e € ' � TEL �m,�s4 � CONTRACTOR r� .e� �3 e .:a [ �� ADDRESS g � �" "'c' CITY ; -c G "f CL- � �� ti%°, ZIP ARCH/ENG/ DESIGNER ADDRESS CITY ZIP TEL. OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempi from the Contractor's State License Law for the reasons) Indicated below by the checkmafk(s), I have placed next to the applicable item(s) {Section 701 Business and Professions Code; Any city or county that requires a permit to construct, alter, improve, demolish, or repair, any structure, prior to Its issuance, also requires the applicant for the permitto file a signed statement that he or she Is licensed pursuant to the provisions of the Contractor's State License Law (Chapter 9) Commending with Section 7040 of Division 3 of the Business and Professions Code] or that he or she is exempt from licensure and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than%ve hundred dollars ($500), O I, as owner of the property, or my employees with wages as their sole compensation, wilt do (-) all of or O portions of the work, and the structure is nut Intended or offered for sale (Sectlon 7044, Business and Processions Code: The Contractors' State License Law does not apply to an owner of properly who, through employees' ar personal effort, builds or improves the property, provided that the Improvements are not intended or offered for sale. If however, the building or improvement Is sold within Due year of completion, the Owner-Bullder will have the burden of proving that It was not built or Improved for the purpose of sale.). O I, as owner of the property, am exclusively contracting with licensed Contractors to construct the project {Section 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds ar improves thereon, and who contracts torthe projects with a licensed Contractor pursuant to the Contractors' State License Law.). U I am exempt from licensure under the Contractor's State License law for the following reason(s): Date; Sign: By my signature below I acknowledge that, except for my personal residence in which I must have resided for at least one year prior to completion of the improvements covered by this permit,) cannot legally sell a structure that I have built as an owner -builder if it has not been constructed in its entirety by licensed contractors. I understand that a copy of the applicable law, Section 7044 of the Business and Professions Code is available upon request when this application is submitted or at the following Web site: httplwwwteginfc.ca.gov/calawhtml. LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full farce and effect. LICENSE CLASS', -�33� Ln Na,, EXP, CATEtg CONTRACTOR:�v,.. WORKER'S COMPENSATION DECLA ATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: I have and will maintain a Certificate of Consent to Self -Insure for Worker's Compensation, as provided by r Section 3700 of the Labor Cade, for the performance of the work for which this permit Is issued, I have and will maintain Worker's Compensation Insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is ( sued. My Worker's Compensation Insurance Carrier and Policy Numher are: CARRIER —EFS,.. POLICY NUMBER NUMBER Vs1 a (THIS SECTION NEED NOT BE COMPLETED IF THF PERMIT IS FOR ONE HUNDRED DOLLARS $1 no OR LESS). I certify that in the performance of the work for whlchthis permit Is Issued, I shall not employ any person In any manner so as to became subject to the Workers Compensation Laws of California, And agree that li 1 should became subject to the Worker's Compensatlan provisions of Section 3700 of the Labor Cade, i shall forthwith comply with those provisions DATE: APPLICANT: WARNING: Failure to secure Worker's Compensation coverage is unlawful, and shall subject an employer to criminal penalties and civil fines up to one hundred thousand dollars ($100,000), In addition to the cost of the compensation, damages as provided for in section 3708 of the labor code, Interest, and attorney's foes. CONSTRUCTION LENDING AGENCY I hereby affirm under penalty of perjury that there Is a Construction Lending Agency for the performance of the work for which this permit Is Issued (Sec. 3037, Clv. C.). LENDER'S NAME: LENDER'S ADDRESS: I certify that I have read this application and state t//tM6v formation Is correct. E agree to comply with all city and county ordinances and state laws relating to buildiion, and hereby authorize representatives of this county to enter upon the alcove-mRintioned property for Inspooses. PERMITTEE NAME (PRINT) SIGNATURE OF PERMITTEE DATE APPLICATION DATE: 912-1114- P/CII# ISSUE DATE: � PERMIT#: PRF�m 8 7+5'� TYPE CONST. OCC GROUP: Scope of Work �o g # DWEL. UNITS # STORIES It BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ. AREA/VALUATION SFR/ADD/RENT Garage/Carport LO Patio/Dock Lu LL Pool/Spa ZRe -Roof Commercial M M Valuation: a i '.',° Adj. Area: QUANTITY DESCRIPTION FEE V U w w cv z m J J V d U CONSTRUCTION: PLAN REVIEW: d z I'll -97 ELECTRIC: 5 . G PLUMBING: MECHANICAL: INSPECTION FEE: ISSUANCE: 49 - T SMTP: e ENERGY P/C: ENERGY PERMIT: RETENTION FEE: PRE -ALT FEE: , 13 BASF: L . PLOT PLAN: ZONING CLEARANCE: TOTAL FEES COMMENTS: q&z.59 PIC: f �g PAID BY: VALIDATION: RECEIPT # 3fa '"C PAID BY / � 1 ry �l� — VALIDATICNi /V WHITE— Department Copy, YELLOW — Finance Copy, PINK— Assessor Copy SETBACK/ LETTER FOOTINGS FORMS SLAB UG. PLUMBING, I HAC; I AND LEDGER SWLLCII GEAR COMMERCIAL HOOD I HnIR NJ IiIICEP I L [l HOT MOP/SHOW/PAN SEPTI(i/(FSVOOL KERS ill PORT AI•CEIVEII DEMOLITION ROOF DRAINS ROUGH CONDUT PODUSPA — UG. EI-FC1111CALI - ...... UFER GROUNfI SF -VIII ii l ATFHAL MAIN WATLR LINE ._.... SLWLR CLEANOUT ROOF SHEATHING F1.0011 SHEATHING SHEAR WALLS EXTER[OR SHEAR WALLS INTERIOR ROUGH PLUMBING - FRAMINGNENTING ROUGH ELECTRICAL ROUGH MECHANICAL ROUGH MECHANICAL ROUGH ELECTRICAL W( ) C ( ) GAS TEST PRE GUNITE POOL PRE DECK BONDING ROUGH PLUMBING INSULATION WALL INSULATION CEILING P -TRAP DRYWALL LATH (PRE) LATH EXTERIOR LATH INTERIOR GAS TEST SCRATCH COAT ELECTRIC METER RELEASE. GAS METER RELEASE SPECIAL INSPECT ION FINAL BUILDING . __- . ..._ . FINAL MECHANICAL FINAL ELECTRICAL FINAL PLUMBING T.C. of OCCUPANCY CERT of OCCUPANCYFINAL FENCE / GATE/ ALARM - . - FINAL POOL WALLS: WALL F007NG/STEEL WALL STEEL 187( ) 2NE( ) LIFT WALL BOND BEAM WALL DRAIN/ SEAL WALL FINAL R0. FRAMING PLANNING APPROVAL ROUGH FIRE APPROVAL _ FINAL FIRE DEPARTMENT FINAL PLANNING FINAL ENGINEERING/ PW FINAL COMMUNITY SERVICES HEALTH DEPT, m1minkma